Failure of imaging to detect optic nerve avulsion: an explanation based on histopathology

Optic Nerve Avulsion and Retinal Detachment After Penetrating Ocular Trauma: Case Report

“…Especially in cases of partial avulsion, imaging methods may not show definitive signs and the diagnosis may be overlooked. 6 Ocular ultrasound cannot be used in early evaluation of many patients due to the recent severe penetrating or blunt trauma. 7 However, radiologic imaging methods should be utilized without delay if ophthalmoscopic examination is inadequate to establish a diagnosis in suspected cases of optic nerve avulsion.…”

Papillopathie traumatique : à propos d’un cas d’arrachement partiel du nerf optique

“…Dans les cas où l'accès au fond d'oeil est impossible, des investigations paracliniques sont nécessaires mais leur contribution est limitée [26] comme le montre l'étude histopathologique de Galor et al [27] : la gaine leptoméningée restant intacte et l'espace crée par la déhiscence des fibres optiques étant de petite dimension et comblé par du sang, l'imagerie est souvent mise à défaut. L'échographie en mode B peut cependant montrer un aspect de fossette hypoécho-gène en arrière de la tête du nerf optique [28] ou un trou dans la paroi du globe dans la région papillaire [20].…”

“…Les signes tomodensitométriques peuvent être un épaississe-ment de la partie antérieure du nerf optique [17,21,23] et parfois une image direct d'avulsion [4,16]. L'imagerie par résonance magnétique (IRM) n'apporte, d'après la littéra-ture, aucune contribution par rapport au scanner [4,27,29].…”

Approach to management of eyes with no light perception after open globe injury

“…[3456789101112] Unfortunately, optic nerve avulsion can be difficult to confirm in the setting of severe globe trauma because the dural sheath often remains attached to the globe even if retrolaminal neural tissue is disrupted. [131415] In contrast to a complete optic nerve transection, an optic nerve avulsion may be partial, and partial return of visual function has been documented in some cases. [15]…”

“…These findings can be demonstrated with CT or MRI imaging, but optic nerve avulsion may be difficult to confirm with neuro-imaging in the setting of acute severe globe trauma [Figure 2]. [131518] Even in the setting of complete optic nerve transection, neuroimaging may reveal what appears to be a surprisingly intact optic nerve complex [Figure 3]. Nonetheless, in some cases, the only way the status of the globe and optic nerve can be explored reliably is with CT/MRI imaging [Figure 4].…”